The effect of initiation of urate-lowering treatment during a gout flare on the current episode: a meta-analysis of randomized controlled trials

Abstract

Objective The objective was to evaluate whether initiation of urate-lowering treatment (ULT) during an acute gout flare prolonged the current episode. Methods A comprehensive search of MEDLINE and Web of Science databases was conducted from their inception to 15 March 2021. Five randomized controlled trials (RCTs) with 381 patients met the inclusion criteria. Standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were used for estimating the clinical efficacy of ULT in acute gout. Results There was no statistical difference in days to resolution (intent-to-treat analysis) (SMD, 0.68; 95% CI − 0.42 to 1.78; I2, 49%; p = 0.22), the pain visual analogue score (VAS) by day 10 (SMD, − 0.07; 95% CI − 0.30 to 0.16; I2, 0%; p = 0.53), C-reactive protein (CRP) from day 7 to 10 (SMD, − 1.14; 95% CI − 5.63 to 3.36; I2, 55%; p = 0.62), erythrocyte sedimentation rate (ESR) from day 7 to 10 (SMD, − 2.51; 95% CI − 5.46 to 0.45; I2, 0%; p = 0.10) and the recurrence of gout flares within 28–30 days (OR 0.78; 95% CI 0.29 to 2.09; I2, 0%; p = 0.62). Conclusion Initiation of ULT during an acute gout flare did not prolong the duration of the flare. However, larger sample size studies are needed to confirm this finding. Trial registration number PROSPERO (CRD42021234581).

The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients

“…ULT is recommended if there are two or more flares per year, tophi and urate arthropathy, or renal calculi [ 16 , 17 ]. Based on a systemic review and meta-analysis, moderate-quality evidence shows that initiating ULT during gout flare does not increase pain severity, the risk of ULT discontinuation [ 44 ], or flare duration [ 45 ]. However, the initiation rate of ULT remains low.…”